Sunday, 20 May 2018

Special Care Dentistry for General Dental Practitioners

The past few weeks have been crazy busy for me so apologies for the silence on my blog. But back with of course my favourite topic: Special Care Dentistry!



This blog post is based on a BDA evening I attended at the end of March with Speakers Mili Doshi, Janine Doughty and Devika Vadher


How is Special Care Dentistry Changing?


I've blogged about what Special Care Dentistry is (click here), but the speciality is facing some particular modern challenges:
  1. Our population is aging
  2. Our population is becoming increasingly complex - 1 in 5 people have a disability. 1 in 4 people have a mental health condition and there has been an increase in life expectancy in those who have a disability
  3. How will we maintain oral health? People are holding onto their natural teeth for longer which can be difficult to maintain as we age. There is also increasing evidence oral health affects systemic health e.g. diabetes and periodontal disease, plaque/poor oral hygiene with aspiration pneumonia
  4. Who is our workforce? Many special care specialists are close to retirement, are we training enough specialists, increasing role of shared care with GDS/CDS/HDS

The most important document to refer to would be NHS England's Commissioning Guide for Special Care Dentistry. This refers to Levels of Care and the expectations of what GDPs, those who work in CDS and specialists are expected to treat. 


What is Social Inclusion Dentistry?


I have previously blogged about Social Inclusion Dentistry (click here). In this area of dentistry, the idea to to reach out to those groups who traditionally have been 'hard to reach', including:

  • Homeless/temporarily housed
  • Sex workers
  • Vulnerable Migrants
  • Travellers
These populations experience specific challenges when trying to access dentistry for example stigma from the profession. Janine who spoke on the topic is an established advocate for these populations and urged us to break down barriers to care for these people, which could be as simple as one lunchtime a month to walk in slots for these patients or volunteering your time for Crisis at Christmas.


Dementia and Dentistry


It has been estimated that 850,000 people suffer from Dementia in the UK and this is increasing as life expectancy is also increasing. The disease is progressive and there is no cure therefore early diagnosis and lifestyle changes are crucial. 

Types of dementia:

  • Alzheimer's disease (62%). More prevalent in females
  • Vascular dementia (17%). More prevalent in males
  • Mixed dementia (10%)
  • Lewy Body dementia (4%)
  • Fronto-temporal dementia (2%)

The relevance of dementia to dentistry is staggering. In patients with dementia, the risk of poor oral health is increased due to memory loss, care-resistant behaviour and cognitive decline. Poor oral health then can seriously negatively impact a patient's quality of life which can be delayed in diagnosis due to difficulties with communication. 

Some adaptations and considerations GDPs can implement include:
  • Assisting in early diagnosis by signposting to GPs when suspicious of dementia diagnosis
  • Making appointments at the beginning of the day when the patient is most likely to be alert
  • Prosthesis construction where they are easy to clean/easy to remove
  • Liaising with carers and key workers where appropriate
  • Making appointments longer so allow for communication
  • Wearing name badges with roles on clearly in sight 
  • 'This is Me' Dementia booklet which communicates patient's beliefs and habits 
  • Familiar staff
  • Avoid jargon, speak slowly and clearly and be patient!

FGDP have recently released guidelines for Dementia in Dentistry


Many thanks to all the speakers from the evening, was wonderful to see some familiar faces and spread the message of special care dentistry!



Do you see patients with dementia or other special care patients? What challenges do you encounter? Let me know in the comments below. 


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